medRxiv preprint doi: https://doi.org/10.1101/2020.06.11.20127936; this version posted June 14, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC 4.0 International license . Coronavirus Disease 2019 (COVID-19): Knowledge, attitudes, practices (KAP) and misconceptions in the general population of Katsina State, Nigeria Murtala Bindawa Isah1*, Mahmud Abdulsalam1, Abubakar Bello1, Muawiyya Idris Ibrahim1, Aminu Usman1, Abdullahi Nasir1, Bashir Abdulkadir1, Ahmed Rufai Usman1, Kabir Matazu Ibrahim1, Aminu Sani2, Ma’awuya Aliu2, Shema’u Abba Kabir3, Abdullahi Shuaibu4 and Shafique Sani Nass5 1Faculty of Natural and Applied Sciences, Umaru Musa Yar’adua University Katsina, Nigeria 2Katsina State Ministry of Health, Katsina State, Nigeria 3Katsina State Primary Healthcare Agency, Katsina State, Nigeria 4National Polio Emergency Operations Center, Abuja, Nigeria 5World Health Organization, North-west Zonal Office, Nigeria. *Correspondence to: Dr Murtala B. Isah, Faculty of Natural and Applied Sciences, Umaru Musa Yar’adua University Katsina, PMB 2218, Katsina State, Nigeria. Email address: [email protected]. Phone No: +2348034651034 Abstract Introduction Over six million cases of Coronavirus Disease 2019 (COVID-19) were reported globally by the second quarter of 2020. The various forms of interventions and measures adopted to control the disease affected people’s social and behavioural practices. Aim This study aims to investigate COVID-19 related knowledge, attitudes and practices (KAP) as well as misconceptions in Katsina state, one of the largest epicentres of the COVID-19 outbreak in Nigeria. Methods The study is a cross-sectional survey of 722 respondents using an electronic questionnaire through the WhatsApp media platform. Results One thousand five hundred (1500) questionnaires were sent to the general public with a response rate of 48% (i.e. 722 questionnaires completed and returned). Among the respondents, 60% were men, 45% were 25-39 years of age, 56% held bachelor’s degree/equivalent and above and 54% were employed. The study respondents’ correct rate in the knowledge questionnaireNOTE: This preprint was reports 80% new researchsuggesting that has high not been knowledge certified by peer of reviewthe disease. and should A not significant be used to guide correlati clinical practice.on (P 1 medRxiv preprint doi: https://doi.org/10.1101/2020.06.11.20127936; this version posted June 14, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC 4.0 International license . < 0.05) exists between the average knowledge score of the respondents and their level of education (τb = 0.16). Overall, most of the respondents agreed that the COVID-19 will be successfully controlled (84%) and the Nigerian government would win the fight against the pandemic (71%). Men were more likely than female (P < 0.05) to have recently attended a crowded place. Being more educated (bachelor’s degree or equivalent and above vs diploma or equivalent and below) is associated with good COVID-19 related practices. Among the respondents, 83% held at least one misconception related to COVID-19, with the most frequent being that the virus was created in a laboratory (36%). Respondents with a lower level of education received and trust COVID-19 related information from local radio and television stations and respondents at all levels of education selected that they would trust health unit and health care workers for relevant COVID-19 information. Conclusion Although there is high COVID-19 related knowledge among the sample, misconceptions are widespread among the respondents. These misconceptions have consequences on the short- and long-term control efforts against the disease and hence should be incorporated in targeted campaigns. Health care related personnel should be at the forefront of the campaign. 2 medRxiv preprint doi: https://doi.org/10.1101/2020.06.11.20127936; this version posted June 14, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC 4.0 International license . Introduction Coronavirus disease 2019 (COVID-19) caused by the SARS-CoV2 virus has been detected in 213 countries and territories, with over 6 million people infected and over 371 000 deaths as of 31th May 2020. The number of people currently infected in Africa was 144 323 with 4099 deaths. Six out of the top seven countries with most COVID-19 cases and deaths were advanced countries (Worldometer, 2020), thus, the disease is capable of overwhelming even the most advanced healthcare systems. The estimated COVID-19 viral reproduction number (R0), a measure of how easily the virus spreads, ranges from 1.4 to 2.5 (WHO, 2020h) or higher (Zhao et al., 2020) which indicates an easily transmittable virus. The virus is transmitted through contact and respiratory routes (WHO, 2020e). The rapid spread of the infection coupled with a short incubation period (2-14 days) (WHO, 2020b) causes an immense burden on the health care system. COVID-19 Case fatality ratios (CFR) of 7.2% in Italy, 2.3 in China and 3.0% in Nigeria have been reported (Onder et al., 2020; WHO, 2020d). The CFR highly fluctuates by country, stage of the pandemic and age group. In Africa, if COVID-19 proceeds unmitigated, an estimated 3.6-5.5 million cases would require hospitalisation among which 52 000 – 107 000 will require intensive care, far more than the burden African healthcare system can handle (WHO, 2020f). Early intervention in the spread of contagious viral infections is crucial to the control of the disease. In previous epidemics caused by other coronaviruses namely; Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) in 2003 and Middle Eastern Respiratory Syndrome (MERS), the World Health Organization (WHO) provided recommendations to break the transmission and spread of the diseases. The recommendations include early disease surveillance, case detection and isolation (Alqahtani et al., 2017; Wilder-Smith et al., 2020). Similar recommendations were used for the COVID-19 outbreak. Other recommended guidelines for the general public to prevent COVID-19 spread include voluntary home quarantine, social distancing and other measures such as frequent hand washing and covering of mouth and nose when coughing or sneezing (Ferguson et al., 2020; WHO, 2020a). Currently there is neither a potent vaccine nor recommended medications to treat the disease (WHO, 2020c). As such, it is likely that most of these measures will be sustained to avoid a second wave or resurgence of the disease. Nigeria recorded its first case of COVID-19 on the 27th February 2020 (NCDC, 2020b) and by the 31st May 2020 the country reported 11 166 confirmed cases and 315 deaths , with the majority of the COVID-19 cases from Lagos state (NCDC, 2020a). Katsina in North-west 3 medRxiv preprint doi: https://doi.org/10.1101/2020.06.11.20127936; this version posted June 14, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC 4.0 International license . Nigeria reported 371 cases with 19 deaths in the same period. Since then, the Katsina state government imposed measures such as the closure of all schools, stay at home order and total lockdown of local government areas with an active transmission of COVID-19. While bans on inter-L.G.A. and Inter-state movements were imposed by Katsina state government and the Federal government respectively. Both the SARS-CoV and MERS epidemics were not reported in Nigeria. However, the emergence of another viral outbreak, Ebola Viral Disease, was accompanied by unusual behaviours and misconceptions (Iliyasu et al., 2015). Similar practices and misconceptions on COVID-19 prompted the WHO to dedicate a domain for myth buster on its website (WHO, 2020c). These include misconceptions such as that the virus is a biological weapon, the virus is not transmitted at higher temperatures and drinking alcohol or hot beverages have a protective benefit against the disease. People’s perception or interpretation of disease outbreaks influences their health care seeking behaviour (Geldsetzer, 2020). As such, COVID-19 control involves understanding the factors associated with people’s behaviour towards the pandemic. For effective control, the uniqueness of various communities needs to be considered, that was why research focusing on diverse communities was required. North-western Nigeria is the most populated geopolitical zone of the country with a population of 48.9 million, a quarter of the national projected population (National Bureau of Statistics, 2018). The Hausa-Fulani ethnic predominantly inhabits the North-west region of Nigeria and the majority of them are Muslims. Previous outbreaks of diseases such as cholera, poliomyelitis, measles and cerebrospinal meningitis have been recorded in the region (Wakabi, 2008). Notably, unhygienic water and improper hand washing practices were associated with a cholera outbreak in the North-western state of Kano in the mid-90s (Hutin et al., 2003). More than a decade later, unhygienic hand washing practices were the main risk factors associated with a cholera outbreak in villages of the Jigawa state of the region (Gidado et al., 2018). A survey conducted between 2013-2017 found that, up to 73% of people in some rural areas of the region do not practice adequate hand washing practices using soap and water (UNICEF, 2020), and this could have a negative implication for the control of water-borne and respiratory diseases (UNICEF, 2017).